Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 216924 | TX |
NPI | 1003579475 |
---|---|
Provider Name | Sierra Orr |
First Address | Dallas, TX 75254-2512 |
Second Address | Arlington, TX 76018-2136 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2021 |
Last Update Date | 21/10/2021 |